Editorial: Tears for 100,000 Nigerian Children killed annually by Cholera

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The latest report by the United Nations Children’s Fund (UNICEF) that over 100,000 Nigerian children less than five years of age die each year due to cholera and other water-borne diseases is scandalous and unacceptable; and a very sad reminder of the endemic poverty of most Nigerians coupled with poor sanitary condition across the country. The report also advertises a certain poverty of ideas and a failure of leadership in the country even in matters that are supposedly routine. Millions of Nigerians live in squalid conditions, without potable water or healthcare facilities, while the citizens are easily exposed to environmental diseases associated with unhygienic environmental condition. This depressing report which indicates an embarrassing shortfall in human development index is a public shame to a nation that should have outgrown primary healthcare challenges.

“The Nigeria Government should invest three times more in the water sector, making sure that every Nigerian has access to clean water and a toilet as the lack of access to water is impacting their well-being, especially the most vulnerable. The lack of WASH facilities in schools is of serious concern as children who do not have access to water are most likely to lose interest in pursuing learning opportunities. Because they are forced to spend more time in search for water during school hours or stay out of school to recover from illness caused by frequent episodes of diarrhea. Access to clean drinking water is a human right - just like the right to food and the right to live without torture and racial discrimination,” UNICEF said in a statement.

According to UNICEF, diseases like diarrhea were responsible for 90% of the death due to unsafe water and sanitation. The report also added that only 13% of schools have access to basic water and sanitation services. The report explained that data from the WASH National Outcome Routine Mapping (WASH NORM) showed that 47 million Nigerians practiced open defecation, and only 11% have access to complete basic water, sanitation and hygiene services. “Ending open defecation and making water, sanitation, and hygiene services available to all Nigerians is one of the biggest challenges as construction and management of facilities requires sustained investments and more partnerships, especially with the private sector,” the report noted.

The latest UNICEF data also reveal that as much as 53% of rural dwellers lack access to improved drinking water against the 75% of urban dwellers. Similarly, another UN World Water Development Report had listed Nigeria among the worst of African countries losing $28.4 billion yearly to lack of access to potable water and basic sanitation. That figure represents 5% of Africa’s Gross Domestic Products (GDP). With the resources at Nigeria’s disposal, it is unacceptable that citizens, especially children, continue to be afflicted with water-borne and sundry communicable diseases. Reports of Nigeria’s performance in all sectors hardly show much to celebrate, as the ranking in all development indices remains very low. Worse still, governments at all levels of Nigeria either lack the political will to face up to the real issues or are too bogged down serving selfish interests to care about the people.

Cholera is an acute gastrointestinal disease caused by Vibrio cholerae. The bacterium generates a soluble toxin in the intestinal tract that activates watery diarrhea leading to extreme loss of fluid, dehydration and collapse. The fatality rate is very high if left untreated, especially among children and infants. Deaths can also occur in adults in a matter of hours after initial presentation. Since it was discovered in 1883 by the German bacteriologist, Robert Koch (1843-1910), cholera has wreaked havoc in different parts of the world, especially in poor countries.

In Nigeria, cholera epidemic has been recurrent for decades due to poor hygiene and poor water supply and use. People commonly urinate and defecate in the open while the wastes are washed into open filthy drains. Besides, the propensity for contamination is very high from roadside food vendors and people eating in unhygienic condition. Not surprisingly, Nigeria continues to record cholera outbreaks with several fatalities, leaving scores hospitalized and stretching facilities to the limits. Urban settlers are not immune to the outbreaks as evidenced by the incident in Lagos where poor handling left a number of residents who patronized public food vendors hospitalized. It is the same story across the country.

The causes are not far-fetched; government’s insensitivity at all levels to the health of the people tops the bill as water supply responsibility is shared among three levels of Federal, states and local governments - Federal for water resources management; states (urban supply) and local governments and communities (rural supply). Apart from issues of poor access to clean water, issues of sanitation are not given adequate attention by Nigerians themselves, at a great risk to their health and survival. Where available, water supply quality is low, according to studies. Investments financed by foreign donors are hardly enough to achieve a significant access. The nation’s population too keeps increasing and there is hardly any sector monitoring as statistics on access to water and sanitation are most times in conflict due to divergent indices and methodologies adopted by agencies.

Available records indicate water and sanitation coverage rates in Nigeria are among the lowest in the world. For example no urban community except Abuja and some parts of Lagos boasts of a credible sewerage system.  There are other challenges including, poor maintenance culture on available water production facilities operating below capacity. Official corruption, low capacity development, erratic electricity supply to the water plants, poorly maintained pipes that promote leakages, non-operational government-owned water systems in small towns which force residents to resort to wells, streams and rivers or any source whatsoever in extreme cases are also debilitating factors.

The National Water Supply and Sanitation Policy approved in 2000 to encourage private sector participation has failed woefully, partly because the policy focused on water supply and neglected sanitation. Too many states with crumbling water supply networks are equally guilty of giving less priority to water and sanitation. But for self-help initiatives by individuals and institutions to drill boreholes in towns and cities, the situation could have been worse. However, either for lack of awareness or wrong attitude to preventive health, matters of sanitation are given little attention by most residents in towns and cities. In real terms, residents have to avail themselves of improved sanitation and clean or treated water and no matter the cost; governments have a duty to be more responsible in the provision of basic health facilities.

The best way to combat cholera and water-borne diseases is through improved sanitation. Through appropriate investments and capacity building for communities, governments can do more to increase access to potable water. Public health awareness is still poor in many areas in spite of claims to the contrary. There should also be regular public enlightenment on personal hygiene, washing of hands, especially, after visiting the toilet and keeping surroundings clean. This presupposes availability of water. Unfortunately, only a few homes have good public water supply. The latest UNICEF report, once again, challenges Nigerian leaders to address basic social amenities that make for good hygiene and improved sanitation. Anti-cholera interventions should be holistic, targeting short-term measures and long-term improvement in human development indices. The government once supported a resolution at the UN to make clean water and sanitation a human right. The time has come for the government to ensure that the human right aspect of that UN resolution receives legal support. Only then, will Nigeria be on track to achieving the Sustainable Development Goal (SDG-6), for clean water and sanitation.